Category Archives: Insanity

The study of insanity in the latter 1800s and early 1900s was in its infancy. Treatment for insanity was often abusive. Diagnosis of insanity was far-reaching and depended on the white man’s definition of normal.

How to Commit

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Elizabeth Packard Being Taken to an Asylum Against Her Will, courtesy National Library of Medicine

Elizabeth Packard Being Taken to an Asylum Against Her Will, courtesy National Library of Medicine

Few patients went to insane asylums voluntarily; most were committed by physicians called in once concerned family members decided a patient’s behavior had reached some sort of tipping point. Committing a patient to an asylum should have been a very serious affair, but it is evident that it was not always done with professionalism and discernment. In an article* published by the American Journal of Insanity (1876), Dr. A. E. MacDonald gave medical students some sound advice about how to examine a patient and determine whether or not to propose commitment.

Dr. Abraham Myerson, Dr. I Veron Brigg, and Dr. Earl K. Holt Examine Defendants, 1934

Dr. Abraham Myerson, Dr. I Veron Brigg, and Dr. Earl K. Holt Examine Defendants, 1934

Many states required the concurrence of two or more physicians to commit a person to an asylum. MacDonald noted that many times a physician–perhaps at the invitation of the family’s physician–was asked to commit a patient to an asylum, rather than to examine a patient. He likened the situation to that of a physician called in to prescribe medicine to a patient without examining him first to see if the medicine were needed. Families would seldom do such a thing, yet with a presumably insane patient, the verdict was often presupposed and the physician essentially called in to rubber-stamp the decision. MacDonald cautioned students to be careful, though, and to examine such a patient thoroughly with an eye to defending himself in a court of law should the patient later sue.

MacDonald went on to say that physicians often encountered two groups within the family: those who wanted the patient committed, and those who didn’t. He also emphasized that much of what he would hear concerning the patient from these family members would be either useless or untrue. He tried to give students a road map of pertinent questions to ask and a systematic way to approach the situation so they could assess a patient objectively.

He also had this bit of advice: “I advise you to make sure of being able at once to recognize your patient from those who may surround him, by learning before you enter the room, some particulars as to his dress or appearance. It is not a little awkward and embarrassing to address yourself to a bystander, under the impression that he is the patient, but it is a mistake that has happened, and might happen again.”

Ambulance Outside Bellevue Psychiatric Hospital, 1895

Ambulance Outside Bellevue Psychiatric Hospital, 1895

*From a lecture delivered before the students of the University of the City of New York, Medical Department, March 10, 1876.

Dance Therapy

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Dance Therapy in New York State Asylum, 1920

Dance Therapy in New York State Asylum, 1920

Physical exercise was seen as therapeutic for mental illness, and the staff at insane asylums employed it in many ways. Patients often labored in asylum gardens and farms, took walks, joined in exercise programs, or otherwise used their bodies in healthful ways. Dancing was one type of movement that asylum managers used for entertainment, reward, and healing. Dancing not only released pent-up energy in an enjoyable way, but it also allowed patients a measure of self-expression. Some who participated in group dances were also able to form social bonds that helped them endure their stay in an asylum.

Edward Elgar

Edward Elgar

Composer Edward Elgar began his career at the Worcester County and City Lunatic Asylum in Powick, England in 1879, at age 21. As bandmaster, he composed many polkas, quadrilles, and minuets for the asylum’s 22-piece (asylum-staff) band; his music was “cheerful, charming, and appropriate to its setting.” Additionally, he and the band gave concerts that also brought the patients enjoyment. Later in his career, Elgar liked to shock listeners by referring to “when I was at the lunatic asylum.”

Music Recovered From Elgar's Early Career

Music Recovered From Elgar’s Early Career

Though he wrote no masterpieces during the five years he composed pieces at the Worcester Asylum, he later went on to write the Enigma Variations and the Pomp and Circumstances Marches.

Dancing in the New Year

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Lunatics Dancing at Blackwell's Island, New York in 1865

Lunatics Dancing at Blackwell’s Island, New York in 1865

Most asylums tried to incorporate decorations and festive activities into their patients’ lives during the Christmas season; the cheerfulness helped many patients and also brightened the morale of staff. Dances were popular entertainments at asylums, and many undoubtedly held special New Year’s Eve dances as an end to the holiday season.

Article About a Dance

Article About a Dance

A reporter attending a New Year’s Eve dance at Middlesex Madhouse in Hanwell (1842) described the participants as looking and behaving like “a crowd of children.” He described the dancing as being of the kind one saw at village fairs, and that the patients didn’t wear uniforms or “workhouse” dresses. Many of the patients definitely enjoyed the activity and talked avidly and gaily, but others seemed anxious, disturbed, melancholy, or uneasy.

There had evidently been a change of management or policy, because the reporter described a girl who had formerly been restrained a great deal of the time and had just recently been released from that treatment. “Her wrists were deformed by the hard leather cases in which they had been confined; and so habituated had she been to wear them at night, that for some time after they had been removed she held up her hands to be bound whenever she went to bed.”

A Twelfth Night Party at Hanwell Lunatic Asylum

A Twelfth Night Party at Hanwell Lunatic Asylum

Though his article was laudatory, the sad picture he painted at the end was the reality many patients at asylums faced. One night of comparative fun and freedom could scarcely make up for it.

A Case of Insanity

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Dr. Isaac Ray, courtesy National Library of Medicine

Dr. Isaac Ray, courtesy National Library of Medicine

Alienists had many interesting theories about insanity and what caused it, and frequently had to explain their views to the public. Court cases involving an insanity defense could create heated debate on the topic, and an article in the October, 1866, issue of the American Journal of Insanity provided a platform for such a discussion.

The case involved Mary Harris, a citizen of the District of Columbia, who shot her former lover dead. She was acquitted and released because of her insanity at the time she committed the crime. Dr. Nichols, superintendent of the Government Hospital for the Insane (St. Elizabeths), testified to her insanity, but did not mean to imply that she was cured of it. There may have been no legal way to keep her confined, however, so she was “let loose upon the community” in the words of the article’s author, Dr. Isaac Ray.

A Gender-Based Cause of Insanity

A Gender-Based Cause of Insanity

Dr. Ray did not discuss the particulars of that case, but instead went on to discuss a “class” of similar cases, where women committed heinous crimes. Because of the “peculiar influence of those organs which play so large a part in the female economy,” said Ray, these criminal acts may have been prompted not so much by motive as by the woman’s physiology. Ray went on to say, “With woman it is but a step from extreme susceptibility to downright hysteria, and from that to overt insanity.” In his opinion, many women who committed crimes like murder (as revenge), had experienced “a strong moral shock and an irritable condition of the nervous system.” He asked, “Is it strange that a person thus situated, should become insane?” (In Harris’s case, he referenced her “uterine derangement.”)

Alice Mitchell Tried to Murder Freda Ward Due to the Exciting Cause of Thwarted Love and Jealousy; She Was Found Insane

Alice Mitchell Tried to Murder Freda Ward Due to the Exciting Cause of Thwarted Love and Jealousy; She Was Found Insane and Committed to the Tennessee State Insane Asylum

Though Ray’s views seem to be compassionate, they were bad news, indeed, for females accused of insanity who might come before him for assessment. Ray was too ready to believe that their gender made them susceptible to insanity, and that it took so little to push them over the edge.

Anyone Could Be Insane

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Alsa Thompson, Age 4

Alsa Thompson, Age 4

Early alienists did not spare many conditions when it came to assessing insanity. Alcohol abuse, syphilis, and epilepsy, were often considered forms of insanity, as were the physical manifestations of a severe form of niacin deficiency called pellagra. Women with severe PMS or menopausal symptoms, or even too much interest in sex, could also be considered insane. Children did not escape that label, either.

Publicity Surrounded This Unusual Case

Publicity Surrounded This Unusual Case

In 1925, seven-year-old Alsa Thompson confessed to poisoning her family by putting sulphuric acid and ant paste in their evening meal. Fortunately, her intended victims found the taste so awful that they didn’t eat more than a bite or two of the meal, but the child’s troubled psyche had been exposed. Further investigation found that she had slashed her five-year-old sister’s wrists with a safety razor (which didn’t kill her), and had poisoned two canaries and a cat.

Judge Walter Gates dismissed the insanity complaint that had been brought against Alsa, but he did feel she needed to be under observation. He remanded Alsa into the custody of parole officer Jean McCracken of the local lunacy commission until she could be transferred to a state institution.

Some Contemporaries Obviously Doubted Alsa's Confession

Some Contemporaries Obviously Doubted Alsa’s Confession

Newspaper accounts of the time mentioned that she did not seem bothered by the accusation and simply stated, “I like to see them die,” when questioned about her motives. Her father vigorously defended her, and others thought she was simply impressionable and confessed to a crime she did not commit.

Early Thoughts on Insanity

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Insane Asylum at Raleigh, North Carolina

Insane Asylum at Raleigh, North Carolina

The more settled eastern states generated most of the research and theory concerning insanity in the 1800s. Most asylum superintendents were both born and educated in the east, and the region produced and trained most asylum superintendents for many years. North Carolina, for example, did not even see a published paper on the topic of insanity from its state medical society until 1871. That paper, “Report of a Case of Violent Cerebral Excitement Relieved by Bromide of Potassium” involved a five-year-old boy. Only the standards of the time could have considered the child insane.

Death by Childbirth Insanity

Death by Childbirth Insanity

The next paper was entitled, “Mania Transitoria” and described momentary insanity that befell people who were otherwise aware of their surroundings and actions. The doctor believed that this transitory state of insanity was related to heredity and certain physical diseases. That theory makes the condition sound like epilepsy, but the author seemed to think that it was something else.

Hysterical Epilepsy, circa 1876

Hysterical Epilepsy, circa 1876

Dr. Grissom attributed the condition to masturbation and petit mal epilepsy as well as the former factors, so it is difficult to know what he is describing. Since many people suffering epilepsy were considered insane during this era, it is quite possible that these episodes of transitory mania sent many otherwise capable men and women to an insane asylum.

Lucid Lunatics

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Life In An Insane Asylum Was Dangerous

Life In An Insane Asylum Was Dangerous

One of the most heartbreaking–and frightening–aspects of treatment in an insane asylum was that so many patients probably were not insane. Native American patients at the Canton Asylum for Insane Indians were rarely evaluated by any competent medical person before they were committed. Powerless and misunderstood, they were often railroaded into the asylum for convenience or spite.

Many white patients undoubtedly suffered the same fate. Women were also politically and financially powerless, and many inconvenient women may have been committed to asylums at the pleasure of their spouses, fathers, or other legal guardians. Diaries and letters that women wrote spoke passionately about how terrible asylums were, and how the rigid routines, loss of freedom, and frightening environment, were enough to make any sane person lose her mind. A woman who had little experience of the world, or who perhaps had never left her home without an escort, would be terrified in an asylum. One can only imagine the stress levels these wronged patients endured.

Patient at Surrey County Asylum, circa 1855, courtesy the Royal Photographic Society Collection, National Media Museum

Patient at Surrey County Asylum, circa 1855, courtesy the Royal Photographic Society Collection, National Media Museum

Diagnoses were also at fault. Medical conditions like epilepsy were considered a part of insanity, and patients who could be effectively treated today, would have spent their lives in insane asylums. Other reasons for commitment were just as tragic. Commitment papers for patients admitted to the Western North Carolina Insane Asylum in Morganton, North Carolina during the two years ending November 30, 1908 included reasons like:

— cigarette smoking

— desire to marry

— cocaine habit

— hard work and nose bleed

Western North Carolina Insane Asylum

Western North Carolina Insane Asylum

Though these diagnoses cannot tell the whole story, modern researchers have to wonder how much mental illness actually accompanied the patients’ conditions.

A Cost Analysis

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Lincoln County Courthouse, circa 1902, located in Canton

Lincoln County Courthouse, circa 1902, located in Canton

Interested parties (mainly in South Dakota) wanted an asylum established exclusively for insane Indians, and tried to make a case for it. They met with a complete lack of support from the superintendent (William W. Godding) of the only other federal institution for the insane, St. Elizabeths. Godding pointed out that the costs to maintain the few insane Indians at St. Elizabeths was less than $3,000 a year, while the proposed asylum in South Dakota would cost $150,000 and need an annual expenditure of at least $25,000 to run it. (See last post.)

However, the Indian Office supported the idea of an asylum, and began to gather figures to show how badly it was needed. St. Elizabeths reported that it had seven Indians in care in 1897 (two had been there close to ten years) for a total cost of $9,506.50 for their entire time as patients. The acting Commissioner of Indian Affairs had no figures as to how many insane Indians might actually need a new asylum’s services, but thought that “an asylum that would accommodate fifty patients would be ample.”

Government Hospital for the Insane of the Army, Navy, and District of Columbia, known commonly as St. Elizabeths

Government Hospital for the Insane of the Army, Navy, and District of Columbia, known commonly as St. Elizabeths

When the Commissioner, William Jones, later canvassed the various reservations to ascertain the number of insane Indians on them, most had none. Of the reservation agents who responded, only 58 Indians were found to be insane, with 7 of that number already in asylums. Agents mentioned other Indians as being “idiotic,” but tellingly, not needing help. One agent said that “a few” on his reservation were slightly insane but not requiring restraint in an asylum. (His estimate is not included in the preceding figure.) Of the 51 potential patients actually on reservations, the agents felt only 34 might need asylum care.

Even if all 58 patients had been taken to St. Elizabeths at a cost of $91/quarter ($364 annually), the total annual cost would have been only slightly over $21,000 a year. That was still under the figure Dr. Godding suggested would be needed to run an asylum in South Dakota each year. Clearly, anyone who did the math could see that even with the added transportation costs to St. Elizabeths, a new asylum really wasn’t worth the money for the few patients that might make use of it. Even paying extra at local state asylums (to offset transporting patients to Washington, DC where St. Elizabeths was located) would have been cheaper.

Yet, the asylum was built, staffed, and infrastructure put in place to support it. A later inspector called the Canton Asylum for Insane Indians a “magnificent political gesture” that had done little good for the recipients it had promised to help.

Canton Asylum Given Much Thought

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Richard F. Pettigrew

Richard F. Pettigrew

Though the Canton Asylum for Insane Indians had many problems throughout its operation, the facility itself had been the subject of much consideration before its construction. When Senator Richard F. Pettigrew, Chairman of of the Committee on Indian Affairs, first proposed Senate Bill 2042 (for the purchase of land and construction thereon of an asylum for insane Indians) in 1897, he asked for “not less than one hundred acres of tillable land” and that the building should be constructed of stone or brick with a metal roof, and “shall be as nearly fire-proof as conditions will permit.”

At the time, a few Indians deemed insane had been admitted to the Government Hospital for the Insane (known as St. Elizabeths) at the rate of $91 per quarter. Payment was through the Commissioner of Indian Affairs. The hospital’s superintendent, William W. Godding, noted that he was presently treating five Indians, and that “this number has never been exceeded at any previous date.”

Center Building, St. Elizabeths, 1900

Center Building, St. Elizabeths, 1900

Godding felt that there would be only a small number of Indians who might need psychiatric care, and that to spend $150,000 to purchase land and erect an asylum (Pettigrew’s proposed figure) was unnecessary. He pointed out that even after the asylum’s construction, the government would need to add “an annual expenditure of not less than $25,000 for the equipment and maintenance of the asylum.” Currently the Government Hospital cared for insane Indians at an annual cost of $2,267.

Dr. William W. Godding, courtesy Library of Congress

Dr. William W. Godding, courtesy Library of Congress

Like many other whites of the era, Godding believed that insanity was actually rare among Indians. He continued, “the additional expenditure [that Pettigrew proposed] might be advisable if there was a prospect . . . the number of insane Indians would be very much increased.” But, Godding stated, “the records of the race do not justify any such expectation, rather the opposite.”

Obviously, Godding’s commonsense objections were ignored.

Arbitrary Commitment

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Elizabeth Packard Being Taken to an Asylum Against Her Will, courtesy National Library of Medicine

Elizabeth Packard Being Taken to an Asylum Against Her Will, courtesy National Library of Medicine

Alienists were notorious for their self-confident belief that they knew what was best for anyone with mental illness. In an essay from the July,1868 issue of the American Journal of Insanity, the (anonymous) author makes a case for doing away with legal procedures for commitment: “. . . other diseases, except those of a highly contagious type, do not call for civil interference nor court publicity.

We do not demand a commission or an inquest to decide whether a man has a fever raging into delirium, or whether he has a general paralysis, or whether a surgeon shall be permitted to amputate his limbs or trepan his skull.”

The writer went on to point out that if anyone saw a person sick or wounded in the street, “we take him forthwith to the nearest hospital, without stopping to canvass our legal right to restrain him of his liberty.”

Charles Guiteau Said He Was Temporarily Insane When He Assassinated President Garfield

Charles Guiteau Said He Was Temporarily Insane When He Assassinated President Garfield

The author lamented that a patient stricken with insanity was sometimes met with a suspicious relative who wasn’t convinced of his illness even though his other relatives were. Because of this suspicion, the patient, “against the wishes and judgment of the rest,” was then liable to the “questioning of the law and its ministers.” This then led to publicity, which might be detrimental to the patient’s recovery.

Though She Had a Trial, Mary Todd Lincoln Was Involuntarily Committed to an Asylum

Though She Had a Trial, Mary Todd Lincoln Was Involuntarily Committed to an Asylum

 

Most people, of course, would not want to be committed involuntarily to an insane asylum, and welcomed legal safeguards to prevent it. It is amazing to consider how differently alienists and laypeople considered the matter–it almost certainly boiled down to who was in control of the situation.